MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke

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The authors compared vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated by thrombosuction in a group of 49subjects with ischemic stroke with 7T MR imaging within 3 months after symptom onset. In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side compared with the contralateral side. They conclude that patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall.

Abstract

BACKGROUND AND PURPOSE

Figure 2 from Lindenholz et al
An 85-year-old man with an occlusion of the left M1–M2 segment (arrow), successfully treated with a thrombosuction device (patient 9 in Table 2). A, Digital subtraction angiography directly before and after the thrombectomy procedure. B, Subtraction image from coregistered pre- and postcontrast vessel wall images confirms a hyperintense configuration at the thrombectomy site. The transverse pre- (C) and postcontrast (D) MPIR-TSE vessel wall images at 7T (voxel size = 0.8 × 0.8 × 0.8 mm3) were obtained 22 days after thrombectomy procedure. The eccentric vessel wall enhancement present after contrast administration is at the same location as the thrombectomy site (arrow, D).

Vessel wall imaging is increasingly performed in the diagnostic work-up of patients with ischemic stroke. The aim of this study was to compare vessel wall enhancement after intra-arterial thrombosuction with that in patients not treated with thrombosuction.

MATERIALS AND METHODS

From 2009 to 2017, forty-nine patients with an ischemic stroke underwent 7T MR imaging within 3 months after symptom onset as part of a prospective intracranial vessel wall imaging study. Fourteen of these patients underwent intra-arterial treatment using thrombosuction (intra-arterial treatment group). In the intra-arterial treatment group, vessel walls were evaluated for major vessel wall changes. All patients underwent pre- and postcontrast vessel wall imaging to assess enhancing foci of the vessel wall using coregistered subtraction images. A Wilcoxon signed rank test was performed to test for differences.

RESULTS

In the intra-arterial treatment group, 11 of 14 patients (79%) showed vessel wall enhancement compared with 17 of 35 patients without intra-arterial treatment (49%). In the intra-arterial treatment group, more enhancing foci were detected on the ipsilateral side (n = 18.5) compared with the contralateral side (n = 3, P = .005). Enhancement was more often concentric on the ipsilateral side (n = 8) compared with contralateral side (n = 0, P = .01). No differences were found in the group without intra-arterial treatment between the number and configuration of ipsilateral and contralateral enhancing foci.

CONCLUSIONS

Patients with intra-arterial treatment by means of thrombosuction showed more (concentric) enhancing foci of the vessel wall ipsilateral compared with contralateral to the treated artery than the patients without intra-arterial treatment, suggesting reactive changes of the vessel wall. This finding should be taken into account when assessing vessel wall MR images in patients with stroke.

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MRI Vessel Wall Imaging after Intra-Arterial Treatment for Acute Ischemic Stroke
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Jeffrey Ross
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